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Medicaid and Medicare

Medicaid

Medicaid is a health insurance program jointly administered and funded by the federal and state government. It provides health care services for eligible, low-income individuals. People qualify for Medicaid by meeting set financial standards and by fitting into a specific coverage group such as children, pregnant women, or individuals who are elderly or who have disabilities. The Georgia Medicaid program is administered by the Georgia Department of Community Health, Division of Medical Assistance.

Medicaid eligibility is extremely complex. Applicants may contact their local department of Family and Children Services (DFCS) to obtain information about Medicaid eligibility, or www.dfcs.dhs.georgia.gov

Medicaid eligibility is determined on an individual, case-by-case basis. Financial requirements include an evaluation of income and resources (assets). Non-financial requirements include Georgia residency, proof of citizenship, and meeting the required level of care for long-term care services.

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Medicaid Services

Medicaid provides a full range of benefits to eligible individuals, including, but not limited to, inpatient and outpatient hospital and clinic services, emergency hospital services, laboratory and x-ray services, physician services, home health services, prescription drugs, home- and community-based long-term care services, nursing facility long-term care services, non-emergency transportation, and payment of Medicare premiums.

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Applying for Medicaid

You can apply for Medicaid at any time, but most people choose to do so when they have problems paying for care. If other Medicaid program requirements are met, then the exhaustion of Partnership Policy benefits is not required in order to qualify for Medicaid.

Applications for Medicaid can be obtained and filed at the local DFCS (in the city or county where the applicant lives or where the nursing facility is located). Applying for Medicaid does not need to be done in person, and a face-to-face interview is not required. Applicants should be sure to mention that they are in need of long-term care services since eligibility rules are different for individuals needing long-term care services. More information is available from the Georgia Department of Human Resources, Division of Family and Children Services.

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Medicare

Medicare was not designed to cover long-term care. It is generally available for people with disabilities and for people over age 65. Medicare pays limited amounts for skilled care following a hospital stay, and it is not intended to cover care that assists people with activities of daily living for long periods of time (long-term care).

Medicare covers the first 100 days of skilled care in a nursing home after a hospital stay of at least 3 days and as long as you enter a nursing home within 30 days of leaving the hospital. Medicare covers some home health care for the treatment of an illness or injury.

Read more about Medicare online.

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